Midline laparotomy is commonly used in emergency and elective cancer surgery and patients need effective and safe pain treatment after this type of surgery. Nowadays modern anticoagulant therapy may prevent use of central regional blocks in pain management. Therefore in the present study the efficacy and safety of rectus sheath analgesia is studied using different administration techniques. The primary aim is the efficacy of the rectus sheath analgesia measured with pain ratings and the amount rescue opioid used.

Secondary aims were concentrations of local anesthetic, rescue opioid and satisfaction to analgesia method used.

Inclusion Criteria: • Body mass index over BMI <35 kg / m2

• not pregnancy/adequate contraception
• no contraindications to the local anaesthetic No contraindications to opioid patient controlled analgesia
• Informed consent obtained

Exclusion Criteria:

• • BMI >35 kg / m2

  • Pregnant or breast feeding
  • Contraindication to local anaesthetics
  • Contraindication to opioids
  • Not able to use patient controlled analgesia pump
  • Relaparotomy
  • No informed consent